shescka
Contributor
Hello good morning everyone
Please help me code this record, I see in findigns like he did 93567 Ascending aortogram and also 75625,26 renal aortogram. I'm confuse with aortograms always
the only one I'm sure is 93455,26.
I will appreciate any guidance
BRIEF HISTORY:
The patient is an 84-year-old man with a known history of coronary
artery disease, status post bypass. On a recent echocardiogram, he was
noted to have severe aortic stenosis. A left heart catheterization was
requested as a workup for proposed TAVR procedure.
DESCRIPTION OF PROCEDURE:
The risks, benefits, and alternatives to the planned procedure were
discussed with the patient, informed consent was obtained, and placed
in the chart. The patient was brought to the cardiac cath lab and
prepped and draped in the usual sterile fashion. Access was
established using a modified Seldinger technique and a 4-French sheath
was placed in the right femoral artery. Please note that patient had
very thick scar and a calcified vessel. We had to dilate the tract
initially with a 4-French dilator and then a stiff micropuncture
dilator before we could put a 4-French sheath in. Once we were able to
place a sheath in, we used a long Amplatz stiff wire to do all the
catheter advances and wire exchanges. A JL5 catheter was used for the
left coronary, a JR4 for the right coronary artery and SVG to diagonal
and OM PDS impression graft. We also used the JR4 catheter to
nonselectively do a LIMA to LAD short. A (____) was used to do an
infrarenal abdominal aortogram and angiogram of the bilateral iliac
arteries. After completion of the procedure, adequate hemostasis was
obtained using manual compression.
FINDINGS:
CORONARY ANGIOGRAM:
1. Left main is normal.
2. LAD is occluded in the mid segment. The left circumflex has
diffuse disease with about 60 percent focal stenosis in the
midsegment and another 50 percent stenosis in the distal
segment.
3. RCA has a mild diffuse disease. The PDA is occluded as similar
to the angiographic appearance back in 2009.
4. SVG to OM1 and right PDA is widely patent. There is no focal
stenosis. There is a sequential graft. The SVG to D2 is patent.
This fills the D1 and proximal LAD retrogradely. LIMA to LAD is
patent.
5. On the ascending aortogram, the root size was normal. There was
no evidence of AI.
6. On the infrarenal abdominal aortogram, there was no evidence of
any tight focal stenosis in either the aorta or bilateral common
iliac, internal iliac or external iliac.
PLAN:
1. Will admit overnight for further workup for TAVR as per Dr.
Beohar.
2. Continue risk factor modification and medical management.
3. Routine groin care.
4. Will plan for TAVR depending on the further workup.
Please help me code this record, I see in findigns like he did 93567 Ascending aortogram and also 75625,26 renal aortogram. I'm confuse with aortograms always
the only one I'm sure is 93455,26.
I will appreciate any guidance
BRIEF HISTORY:
The patient is an 84-year-old man with a known history of coronary
artery disease, status post bypass. On a recent echocardiogram, he was
noted to have severe aortic stenosis. A left heart catheterization was
requested as a workup for proposed TAVR procedure.
DESCRIPTION OF PROCEDURE:
The risks, benefits, and alternatives to the planned procedure were
discussed with the patient, informed consent was obtained, and placed
in the chart. The patient was brought to the cardiac cath lab and
prepped and draped in the usual sterile fashion. Access was
established using a modified Seldinger technique and a 4-French sheath
was placed in the right femoral artery. Please note that patient had
very thick scar and a calcified vessel. We had to dilate the tract
initially with a 4-French dilator and then a stiff micropuncture
dilator before we could put a 4-French sheath in. Once we were able to
place a sheath in, we used a long Amplatz stiff wire to do all the
catheter advances and wire exchanges. A JL5 catheter was used for the
left coronary, a JR4 for the right coronary artery and SVG to diagonal
and OM PDS impression graft. We also used the JR4 catheter to
nonselectively do a LIMA to LAD short. A (____) was used to do an
infrarenal abdominal aortogram and angiogram of the bilateral iliac
arteries. After completion of the procedure, adequate hemostasis was
obtained using manual compression.
FINDINGS:
CORONARY ANGIOGRAM:
1. Left main is normal.
2. LAD is occluded in the mid segment. The left circumflex has
diffuse disease with about 60 percent focal stenosis in the
midsegment and another 50 percent stenosis in the distal
segment.
3. RCA has a mild diffuse disease. The PDA is occluded as similar
to the angiographic appearance back in 2009.
4. SVG to OM1 and right PDA is widely patent. There is no focal
stenosis. There is a sequential graft. The SVG to D2 is patent.
This fills the D1 and proximal LAD retrogradely. LIMA to LAD is
patent.
5. On the ascending aortogram, the root size was normal. There was
no evidence of AI.
6. On the infrarenal abdominal aortogram, there was no evidence of
any tight focal stenosis in either the aorta or bilateral common
iliac, internal iliac or external iliac.
PLAN:
1. Will admit overnight for further workup for TAVR as per Dr.
Beohar.
2. Continue risk factor modification and medical management.
3. Routine groin care.
4. Will plan for TAVR depending on the further workup.
